Snoring affects approximately 50% of men and 30% of women and is commonly caused by the oscillation of the uvula, the free edges of the soft palate (also known as the velum or muscular plate) and the faucial pillars. Chronic snorers often report restless sleep, morning headaches and excessive fatigue. Other common findings are memory and concentration difficulties, behavioral changes including irritability, impotence and loss of alertness, and even sudden death from accidents or cardiovascular complications.
Snoring is a precursor to obstructive sleep apnea syndrome (OSA), and can be a risk factor for hypertension, cardiac arrhythmias, angina pectoris, cerebral infarction, pulmonary hypertension and congestive heart failure, all of which are commonly associated with OSA. OSA is the most common type of sleep apnea and results from the collapse of the pharyngeal wall in response to negative inspiratory pressure in the upper airway. Hypotonicity of the pharyngeal musculature allows the upper airway to collapse even at the most modest negative inspiratory pressures, leading to snoring or apnea. The collapse occurs when the negative pressure within the pharynx exceeds the ability of its walls and musculature to maintain a patient airway. Any narrowing along the upper airway will increase the pressure and subsequently promote further narrowing or will require an increase in the velocity of airflow, further reducing intraluminal pressure.
A redundant palate or elongated or thick uvula can also cause snoring from the rapid airflow created by inspiratory pressure. Further anatomic narrowing or obstruction anywhere along the upper airway can cause OSA. Other causes of physiologic dysfunction of neuromuscular and respiratory control mechanisms can also cause OSA.
Various methods have been developed to treat snoring and OSA. Uvulopalatopharyngoplasty (UPPP) was first designed as a surgical treatment for snoring and was later applied to OSA. UPPP is performed by removing the anterior surface of the soft palate and uvula and suturing the uvula to the soft palate. There are, however, risks associated with UPPP such as causing excess scar tissue to tighten the airway and actually making the airway smaller than before UPPP.
Laser assisted uvulopalatoplasty (LAUP) was developed as an alternative to UPPP to treat OSA. LAUP is performed by using a laser, typically a CO2 laser, to remove parts of the uvula. LAUP also has its risks, as the scar tissue from the laser can reduce the airspace in the pharynx, leading to velopharyngeal insufficiency. The scar tissue can also make the airway more prone to collapse during sleep.
Several other procedures have also been developed to treat OSA. For example, somnoplasty uses radiofrequncy ablation to cause coagulation necrosis (clotting) in the tissue in a patient's mouth. Pillar implants can be inserted into a patient's soft palate to cause the palate to stiffen. Sclerotherapy uses a medicinal injection to shrink blood vessels. Each of these alterative procedures also has associated disadvantages. For example, these alternative procedures do not allow a doctor to lift and suspend the soft palate. These procedures are also permanent, that is, once the tissue is removed, it cannot be replaced.